AAPM&R Partnership Questionnaire

Thank you for your interest in collaborating with the American Academy of Physical Medicine and Rehabilitation (AAPM&R).

The purpose of this questionnaire is to obtain information which will allow AAPM&R to review all partnership or cross-marketing requests in a standardized, timely manner. Answers to these questions will determine whether staff, committees and/or Board members need to be involved in the assessment. You can expect a response within 1-2 weeks of your request.

Contact Information

Name:
Title:
Company/Affiliation:
Phone Number:
Email Address:
Date of Submission:

1. Are you a member of AAPM&R?

2. Identify any other organization(s) that may be involved in relation to this request.

3. Briefly describe your affiliation with the organization identified in question 2.

4. Provide background information on the organization in question 2, its mission, membership demographics and organizational strategic priorities. (100 words or less)

5. Identify any other organizations that are currently involved in the proposed collaboration.

6. Describe the nature of the proposed collaboration request including any specific associated deadlines. (100 words or less)

Explain:

7. What are the goals of the proposed collaboration and benefits for each of the organizations involved in the proposed collaboration? (150 words or less)

8. What are the mechanisms in place to evaluate the effectiveness of the proposed collaboration? (100 words or less)